2 - TNF Inhibitors Flashcards Preview

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Flashcards in 2 - TNF Inhibitors Deck (44):
1

Increased lesion and serum TNF-alpha levels correlate with severity of psoriasis

True

2

TNF-alpha is a Th1 (T-helper 1 cell) cytokine that stimulates keratinocyte proliferation which then releases additional pro inflammatory cytokines

True

3

TNF-alpha upregulates intracellular adhesion molecules on the surface of endothelial cells

True

4

TNF-alpha is chemotactic for neutrophils

True

5

Decreased liver function (such as in patients with liver disease) does not affect the efficacy of etanercept

True

6

Etanercept can be used in patients with active hepatitis C infection

True (no adverse effects in these patients)

7

Etanercept is a fully human dimeric fusion protein RECEPTOR that binds to both soluble and membrane bound TNF-alpha as well as TNF-beta

True

8

The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are Pregnancy Category B

True

9

The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are relatively contraindicated in patients with family history of demyelinating diseases i.e. Multiple sclerosis

True

10

The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) is absolutely contraindicated in the setting of active or chronic infections

True

11

Etanercept affects the mortality of patients with moderate to severe hepatitis

True (small clinical trial showed increased mortality)

12

The TNF-alpha inhibitors have been associated with reactivation of Hep B fulminant hepatitis and caution and antiviral therapy is advised even without active disease

True

13

2% of Etanercept patients will develop non-neutralising autoantibodies (not anti-drug antibodies)

True (and so these autoantibodies are not associated with ineffective treatment or adverse events)

14

The most common adverse event associated with Etanercept is injection site reaction

True (delayed hypersensitivity type reaction)

15

Anakinra (an IL-1 antagonist) used in conjunction with the TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) is associated with an increased risk of serious infections

True

16

Live-vaccines are absolutely contraindicated in patients on Etanercept (and other biological agents)

True (any vaccine is acceptable EXCEPT live-vaccines)

17

Etanercept pre filled syringes stored in the refrigerator should be allowed to return to room temperature 15 minutes before injecting in order to reduce injection-related pain

True

18

Infliximab is a CHIMERIC IgG monoclonal antibody specific to TNF-alpha

True

19

The neutralising anti-drug antibodies in Infliximab treated patients may reduce efficacy of Infliximab in a minority of patients

True

20

Infliximab neutralises soluble TNF-alpha and blocks membrane bound TNF-alpha

True

21

Etanercept prevents TNF-alpha from binding to any cell surface receptors

True

22

Infliximab should not be given to any patient with a hypersensitivity to murine (mouse) proteins

True (derived from mouse and human sources)

23

Infliximab >5mg/kg is absolutely contraindicated in patients with congestive cardiac failure

True (absolute contraindication for >5mg/kg - significant mortality and hospitalisation, OK for lower dose)

24

Infliximab may be prescribed in HIV patients

True (HIV patients with low viral loads and normal CD4 counts have tolerated Infliximab)

25

20% of Infliximab patients experience infusion reactions

True

26

Anti-drug antibodies to Infliximab is associated with an increased clearance rate of Infliximab and reduced efficacy

True

27

Anti-drug antibodies to Infliximab is associated with an increased incidence of infusion reactions

True

28

Higher antibody titres of anti-drug antibodies to Infliximab corresponds to severity of infusion reactions or serious infectious complications

False

29

Increasing the dose per kg or shortening the interval between doses combats the formation of anti-drug antibodies to Infliximab

True (other methods include premedicating with oral corticosteroids and concomitant immunomodulatory therapy I.e. Methotrexate)

30

Infliximab has been associated with hepatotoxicity

True (active liver failure, autoimmune hepatitis, jaundice, cholestasis)

31

Adalimumab is a fully human IgG recombinant monoclonal antibody to TNF-alpha

True

32

All 3 TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are metabolised via proteolysis and excreted into the bile and urine

True

33

The most common adverse event for Adalimumab is injection site reaction

True

34

The rate of neutralising (anti-drug) antibody production for Adalimumab was 5%, with no correlation with adverse event or disease activity

True

35

Methotrexate can reduce the clearance of Adalimumab after multiple dosing, but this does not reduce Adalimumab's efficacy

True

36

There is an increased risk of active TB infection with the TNF-alpha inhibitors

True (monoclonal antibodies Infliximab and Adalimumab associated with higher rates than Etanercept)

37

Once TB infection has been treated, TNF-alpha inhibitors can be started

True

38

Invasive fungal infections are associated with TNF-alpha inhibitors treatment

True

39

TNF-alpha inhibitors are contraindicated in chronic carriers of Hepatitis B (Hep B surface antigen positive)

True (there is risk of reactivation of Hepatitis B and clinicians are cautioned before using these drugs in patients with history of Hep B)

40

Patients with congestive cardiac failure should use TNF-alpha inhibitors with caution

True

41

Positive ANA and anti-dsDNA induction has been associated with the TNF-alpha inhibitors, although the incidence of drug-induced lupus/SLE/lupus-like syndrome remains low

True

42

TNF-alpha inhibitors may rarely cause haematologic toxicity (leukopenia, neutropenia, thrombocytopenia, pancytopenia)

True

43

The risk of lymphoma and skin cancer is unclear in patients on TNF-alpha inhibitors

True

44

Patients with underlying conditions that predispose to infection i.e. Diabetes should be monitored closely whilst on TNF-alpha inhibitors

True (it is reasonable to withdraw therapy in patients with active infections)